Inter-observer variability in sizing fenestrated and/or branched aortic stent-grafts

Area of Science:

• Vascular Surgery
• Medical Imaging
• Biomedical Engineering

Background:

• Limited data exists on inter-observer variability for complex aortic aneurysm measurements.
• Standard EVAR (endovascular aneurysm repair) measurement variability is better understood.
• Complex aortic aneurysms require precise measurements for stent-graft sizing.

Purpose of the Study:

• To assess inter-observer variability in preoperative measurements for fenestrated and/or branched EVAR (f/b-EVAR).
• To identify critical discrepancies in measurements that could affect clinical results.
• To provide insights into sizing accuracy for complex aortic aneurysm repair.

Main Methods:

• Two independent observers reviewed CT scans from 268 patients in a French f/b-EVAR trial.
• Measurements included aneurysm extent, target vessel stenosis, aortic diameters, proximal landing zone, device diameter, and target vessel position.
• Reproducibility was assessed using kappa statistics, Bland-Altman plots, and Passing-Bablok regression.

Main Results:

• Overall moderate to almost perfect reproducibility was observed for most measurements.
• Critical discrepancies were noted in target vessel clock position (≥45 minutes) and location (≥5 mm).
• Discrepancies also occurred in proximal landing zone level and endograft diameters.

Conclusions:

• This study represents the first large-scale analysis of inter-observer variability in f/b-EVAR sizing.
• While measurement agreement was generally good, specific critical discrepancies were identified.
• These discrepancies highlight potential challenges that may influence clinical outcomes in f/b-EVAR procedures.